MEDICARE: DEBRA KILLMON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	014200-1	NY

General Provider Information

NPI Number	:	1356747216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA KILLMON

Provider Business Mailing Address
First Line	:	166 W 76TH ST
Second Line	:	5B
City	:	NEW YORK
State	:	NY
Zip	:	10023-8408
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	166 W 76TH ST
Second Line	:	5B
City	:	NEW YORK
State	:	NY
Zip	:	10023-8408
Country	:	US
Telephone Number	:	917-691-7217
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/05/2014
Last Update Date	:	11/05/2014

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Directions to “ DEBRA KILLMON ” Practice Location

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